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Über problematisch internetnutzende Frauen fehlen trotz zunehmender Forschungsaktivitäten weiterhin ausreichend Kenntnisse, um zielgruppengerechte Versorgungsangebote zu gestalten. Diese Dissertation hat zum Ziel, (1) zu beschreiben, wie sich eine problematische Internetnutzung bei Frauen in ihren Merkmalen und Ausprägungen zeigt, (2) aus biografischer Perspektive zu erklären, wie eine problematische Internetnutzung bei Frauen entstehen kann und (3) Implikationen für die Versorgungspraxis abzuleiten. Dazu wurden im Rahmen eines qualitativen Forschungsdesigns n=24 teilnarrativ-biografische Interviews mit gern/intensiv und problematisch internetnutzenden Frauen geführt. Die Auswertung erfolgte in drei Teilstudien mittels qualitativer Inhaltsanalyse sowie rekonstruktiv-hermeneutischer Analysezugänge in Anlehnung an das Integrative Basisverfahren. Die Ergebniszusammenführung zeigt, dass ein hohes biografisches Belastungserleben Frauen hinsichtlich einer problematischen Internetnutzung vulnerabel machen kann. Entscheidend ist aber nicht die Existenz der Belastungsfaktoren an sich, sondern mit welchen Lebensbewältigungsstrategien ihnen begegnet wird und welche Bedeutung die Internetnutzung als Lebensbewältigungsstrategie dabei hat. Die Versorgungspraxis sollte u. a. dahingehend optimiert werden, gemeinsam mit Betroffenen die biografische Bedeutung der Internetnutzung und das ‚eigentliche‘ Problem dahinter zu reflektieren.

Uvod: Poporodna depresija je ena izmed najbolj pogostih komplikacij postnatalnega obdobja. Pogosto ostane neodkrita in le majhen odstotek žensk se odloči za zdravljenje. Zaradi številnih dejavnikov, ki odvračajo obolele od vključevanja k standardnim oblikam zdravljenja, postajajo priljubljeni alternativni in komplementarni pristopi. Telesna aktivnost je ena izmed potencialno učinkovitih oblik preprečevanja in lajšanja simptomov poporodne depresije, vendar njen vpliv še ni dobro raziskan. Namen: Zanimanje za komplementarne oziroma alternativne pristope pri obravnavi poporodne depresije poudarja pomembnost, da le-te dobro raziščemo. Telesna aktivnost predstavlja potencialno nizkocenovno in lahko dostopno metodo preprečevanja in obvladovanja poporodne depresije, zato želimo z diplomskim delom opredeliti njeno učinkovitost. Ugotavljali bomo, ali je prenatalna telesna aktivnost učinkovita pri preprečevanju nastanka poporodne depresije ter kako telesna aktivnost vpliva obolele ženske. Metode dela: Uporabljena je bila deskriptivna metoda dela s pregledom angleške znanstvene literature, ki je bila objavljena med leti od 2017 do 2022. Zbiranje literature je potekalo preko podatkovnih baz PubMed (Medline), ScienceDirect in Cinahl (EBSCO) ter preko Google Učenjaka. Skupno smo za odgovor na raziskovalni vprašanji uporabili 12 enot literature, ki se je po hierarhiji dokazov uvrščala vsaj na 3. nivo. Rezultati: Telesna aktivnost je učinkovita metoda preprečevanja in lajšanja simptomov poporodne depresije. Razprava in zaključek: Telesna aktivnost prinaša številne pozitivne koristi za fizično in psihično zdravje žensk v perinatalnem obdobju. Nima neželenih stranskih učinkov in je varna komplementarna metoda preprečevanja in obvladovanja poporodne depresije. Potrebnih je več kakovostnih študij, ki bi natančneje opredelile moč učinka telesne aktivnosti na simptome poporodne depresije in vlogo različnih modalitet pri njeni učinkovitosti. Introduction: Postpartum depression is one of the most common complications of the postpartum period. It is frequently overlooked and only a small percentage of women seek treatment. Alternative and complementary approaches are gaining popularity due to the many factors that repel impacted women from engaging in standard forms of treatment. Physical activity is one of the potentially effective methods of preventing and alleviating the symptoms of postpartum depression but its impact has not yet been adequately studied. Purpose: Interest in complementary or alternative ways of treating postpartum depression underscores the importance of studying them thoroughly. Physical activity could be a low-cost and easily accessible method of preventing and managing postpartum depression. Because of that, the aim of this diploma work is to define its effectiveness. We want to determine whether prenatal physical activity is effective in preventing postpartum depression and how physical activity affects sick women. Methods: We used a descriptive method of work with a review of the English scientific literature that was published between 2017 and 2022. The literature collection was performed through PubMed (Medline), ScienceDirect, and Cinahl (EBSCO) databases and by Google Scholar. In total, we used 12 units of literature to answer the research questions, which, according to the hierarchy of evidence, were classified at least as level 3. Results: Physical activity is an effective method for preventing and alleviating the symptoms of postpartum depression. Discussion and conclusion: Physical activity provides many benefits for women's physical and psychological health during their perinatal period. It has no adverse side effects and is a safe complementary approach to the prevention and management of postpartum depression. Higher quality studies are necessary to better define the strength of the effect of physical activity on postpartum depression symptoms and the role of different modalities in its effectiveness.

Mark Mohan Kaggwa,1 Brendah Namatanzi,2 Moses Kule,3 Rahel Nkola,1 Sarah Maria Najjuka,4 Firoj al Mamun,5,6 Ismail Hosen,5,6 Mohammed A Mamun,5,6 Scholastic Ashaba1 1Department of Psychiatry, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda; 2Faculty of Health Sciences, Lira University, Lira, Uganda; 3Department of Psychiatry, Mbarara Regional Referral Hospital, Mbarara, Uganda; 4College of Health Sciences, Makerere University, Kampala, Uganda; 5CHINTA Research Bangladesh, Savar, Dhaka, 1342, Bangladesh; 6Department of Public Health and Informatics, Jahangirnagar University, Savar, Dhaka, 1342, BangladeshCorrespondence: Mark Mohan KaggwaDepartment of Psychiatry, Faculty of Medicine, Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, UgandaEmail kmarkmohan@gmail.comBackground: Rural women are highly prevalent to depression, where spouse-related factors, including extramarital affairs and poverty, intensify its likelihood of occurrence. However, women engaged with a Money-Saving Group (MSG) are financially self-dependent, which can reduce the risk of depression suffering. Despite this, there is less study among this cohort, which led us to investigate the prevalence and associated factors of depression among the Ugandan women involved in MSG.Methods: This was a cross-sectional study in Uganda among rural married or cohabiting women aged 18 to 45 years engaged in MSG. The survey was carried out within a total of 153 participants (33.3 ± 6.7 years) in April 2021. Information related to socio-demographic of the participants, their spouse characteristics, and depression were collected.Results: About 65.4% of the participants had depressive symptoms (based on the cutoff 10/27 at the PHQ-9). But, 8.15 times (CI: 2.83– 23.44, p< 0.001) and 16.69 times (CI: 4.85– 57.39, p< 0.001), higher risk of depression were observed, if the participants’ spouses were using an addictive substance and had been involved in an extramarital relationship, respectively. Similarly, there was an increased likelihood of depression when the participant or spouse was unemployed.Conclusion: This study observed a higher prevalence of depression, which suggests paying attention to this cohort. Thus, there should be routine screening for depression among married women involved in MSG at lower-level health facilities in rural settings, especially those with spouses engaged in substance use, having an extramarital relationship, and being unemployed.Keywords: depression, married women, spouse extramarital affairs, rural Uganda, women’s mental health, extramarital relationship, money-saving group, substance use, spouse substance use, poverty, addiction

Diplomsko delo predstavi kakšno je duševno zdravje žensk v občini Črenšovci, s kakšnimi težavami se morebiti soočajo, kaj pozitivno vpliva na njihovo zdravje in kaj ga poslabšuje. Prav tako so predstavljene izkušnje žensk bivanja v psihiatrični bolnišnici, torej kakšno je bilo njihovo počutje znotraj institucije, kaj se jim zdi, da jim je institucija dala in kaj je je morda vzela. V teoretičnem delu sem predstavila najprej nekaj osnovnih značilnosti duševnega zdravja, nato sem se osredotočila na tri najpogostejše oblike težav v duševnem zdravju, s katerimi se soočajo ženske na podlagi številnih raziskav. Sledi predstavitev odvisnosti ter oblike pomoči, na katere se lahko ženske obrnejo v primeru težav v duševnem zdravju. Poudarek je bil tudi na institucionalni oskrbi, v okviru česa sem predstavila Psihiatrično bolnišnico Ormož, saj so vse moje intervjuvanke imele izkušnjo bivanja v tej instituciji. Uporabila sem kvalitativno raziskovanje in s pomočjo delno strukturiranega intervjuja intervjuvala osem žensk iz občine Črenšovci z izkušnjo bivanja v psihiatrični bolnišnici. Cilj raziskave je bil opozoriti na problematiko duševnega zdravja žensk z izkušnjo bivanja v psihiatrični bolnišnici v občini Črenšovci ter osvetliti njihove izkušnje bivanja v instituciji. Skozi nalogo izpostavljam pomen govora o temi duševnega zdravja, o kateri se v manjših vaseh ne govori dovolj in na tak način poskušam ozaveščati in informirati ženske. Raziskava je pokazala, da je duševno zdravje žensk slabše kot sem pričakovala in da se te težave pokažejo v oblikah kot so stres, težave z 'živci', depresija in osamljenost. Težava žensk je tudi slaba oziroma ne dovolj razširjena socialna mreža, ter slabi odnosu znotraj družine, v nekaterih primerih pa prihaja tudi do nasilja v družini. Na način življenja v instituciji so se ženske s časom privadile, kljub temu da jim je bilo na začetku precej težko. Institucija jim je vzela marsikaj, česar ženske sploh niso izpostavile, verjetno tudi zaradi tega, ker so se bile prisiljene kar hitro prilagoditi načinu življenja v instituciji. Sama menim, da lahko ženskam pomagamo na zelo različne načine z vzpostavljanjem skupnostnih služb, brez tega, da jih zapiramo v institucije. The graduation thesis presents the mental health of women in the municipality of Črenšovci, what problems they may face, what has a positive effect on their health and what makes it worse. The experiences of women staying in a psychiatric hospital are also presented, that is, how they felt inside the institution, what they think the institution gave them and what it may have taken. In the theoretical part, I first presented some basic characteristics of mental health, then I focused on the three most common forms of mental health problems that women face based on a number of studies. What followed is a presentation of addiction and forms of help that women can turn to in case of mental health problems. The emphasis was also on institutional care, in the framework of which I presented the Ormož Psychiatric Hospital, as all my interviewees had the experience of living in this institution. I used qualitative research and, with the help of a partially structured interview, interviewed eight women from the municipality of Črenšovci with experience of living in a psychiatric hospital. The aim of this research was to draw attention to the issue of mental health of women with the experience of living in a psychiatric hospital in the municipality of Črenšovci and to shed light on their experience of living in an institution. Through the assignment, I highlight the importance of talking about the topic of mental health, which is not talked about enough in smaller villages, and with it, I try to raise awareness and inform women. Research has shown that women’s mental health is worse than I expected and that these problems manifest themselves in forms such as stress, ‘nerve’ problems, depression and loneliness. The problem of women is also a poor or insufficiently widespread social network and poor relationships within the family, in some cases there is also domestic violence. Women became accustomed to the way of life in the institution over time, despite the fact that it was quite difficult for them at the beginning. The institution took away many things from them, which the women did not expose in its entirety, probably also because they were forced to quickly adapt to the way of life in the institution. I myself believe that we can help women in very different ways by setting up community services, without locking them up in institutions.

The current worldwide outbreak of COVID-19 has changed the modus operandi of all segments of society. While some pandemic-related stressors affect nearly everyone, many especially affect women. Purpose: To review what is known about the pandemic’s effect on women’s mental health, what makes them more predisposed to vulnerabilities and adverse impacts, and strategies for preventing and treating these mental health consequences in the female population during specific stages across the lifespan. Methods: The authors performed a narrative review in combination with their observations from clinical experience in the field of women’s mental health and reproductive psychiatry. Articles on women’s mental health and COVID-19 up to May 30, 2020, were searched using the electronic PubMed and PsychInfo databases, as well as publications by major health entities (e.g., World Health Organization, Centers for Disease Control and Prevention, the United Nations) and press releases from prime communication outlets (e.g., National Public Radio). Results and conclusions: Women who are pregnant, postpartum, miscarrying, or experiencing intimate partner violence are at especially high risk for developing mental health problems during the pandemic. Proactive outreach to these groups of women and enhancement of social supports could lead to prevention, early detection, and prompt treatment. Social support is a key protective factor. Similarly, parenting may be substantially more stressful during a pandemic. Gender disparities may be accentuated, particularly for employed women or single parents, as women are disproportionately responsible for the bulk of domestic tasks, including childcare and eldercare.

Despite significant biological, psychological, and social challenges in the perimenopause, most women report an overall positive well-being and appear to be resilient to potentially negative effects of this life phase. The objective of this study was to detect psychosocial variables which contribute to resilience in a sample of perimenopausal women. A total of 135 healthy perimenopausal women aged 40–56 years completed a battery of validated psychosocial questionnaires including variables related to resilience, well-being, and mental health. First, using exploratory factor analysis, we examined which of the assessed variables related to resilience can be assigned to a common factor. Second, linear regression analyses were performed to investigate whether a common resilience factor predicts well-being and mental health in the examined sample of women. Optimism (LOT-R-O), emotional stability (BFI-K-N), emotion regulation (ERQ), self-compassion (SCS-D), and self-esteem (RSES) in perimenopausal women can be allocated to a single resilience-associated factor. Regression analyses revealed that this factor is related to higher life satisfaction (SWLS; β = .39, p R2 = .20), lower perceived stress (PSS-10; β = − .55, p R2 = .30), lower psychological distress (BSI-18; β = − .49, p R2 = .22), better general psychological health (GHQ-12; β = − .49, p R2 = .22), milder menopausal complaints (MRS II; β = − .41, p R2 = .18), and lower depressive symptoms (ADS-L; β = − .32, p R2 = .26). The α levels were adjusted for multiple testing. Our findings confirm that several psychosocial variables (optimism, emotional stability, emotion regulation, self-compassion, and self-esteem) can be allocated to one common resilience-associated factor. This resilience factor is strongly related to women’s well-being as well as mental health in perimenopause.

Background: The prevalence and comorbidity of anxiety disorders are significantly different between women and men, with research showing a greater impact on women. The aim of this review was to identify the psychosocial and biological factors that have been considered to explain this gender and sex difference in prevalence and determine whether these factors are related to any anxiety comorbidity differences between men and women. Methods: Following the PRISMA guidelines, we carried out a systematic review of studies published between 2008 and 2021 in PsycINFO and PubMed databases. Empirical and review studies evaluating psychosocial and biological factors that could influence the difference in prevalence and comorbidity between men and women were included. A qualitative narrative synthesis was performed to describe the results. Results: From 1012 studies, 44 studies were included. Retrieved articles were categorized depending on their object of study: psychosocial factors (n = 21), biological factors (n = 16), or comorbidity (n = 7). Results showed that differences in anxiety between women and men have been analyzed by psychosocial and biological factors but rarely together. Among the psychosocial factors analyzed, masculinity may be a protective factor for anxiety development, while femininity can be a risk factor. In the studies that took biological factors into account, the potential influence of brain structures, genetic factors, and fluctuations in sexual hormones are pointed out as causes of greater anxiety in women. Concerning comorbidity, the results noted that women tend to develop other internalizing disorders (e.g. depression), while men tend to develop externalizing disorders (e.g. substance abuse). Conclusions: For an accurate understanding of differences between women and men in anxiety, both biological and psychosocial factors should be considered. This review highlights the need to apply the biopsychosocial model of health and the gender perspective to address differences in anxiety between sexes.

BackgroundInvestigating obstetric near misses (life-threatening obstetric complications) provides crucial information to prevent maternal mortality and morbidity.AimsTo investigate the rate and type of obstetric near misses among women with serious mental illness (SMI).MethodWe conducted a historical cohort study, using de-identified electronic mental health records linked with maternity data from Hospital Episode Statistics. The English Maternal Morbidity Outcome Indicator was used to identify obstetric near misses at the time of delivery in two cohorts: (1) exposed cohort – all women with a live or still birth in 2007–2016, and a history of secondary mental healthcare before delivery in south-east London (n = 13 570); (2) unexposed cohort – all women with a live or still birth in 2007–2016, resident within south-east London, with no history of mental healthcare before delivery (n = 223 274).ResultsThe rate of obstetric near misses was 884.3/100 000 (95% CI 733.2–1057.4) maternities in the exposed group compared with 575.1/100 000 (95% CI 544.0–607.4) maternities in the unexposed group (adjusted odds ratio 1.6, 95% CI 1.3–2.0, P < 0.001). Highest risks were for acute renal failure (adjusted odds ratio 2.1, 95% CI 1.1–3.8, P = 0.022); cardiac arrest, failure or infarction (adjusted odds ratio 2.3, 95% CI 1.1–4.8, P = 0.028); and obstetric embolism (adjusted odds ratio 3.1, 95% CI 1.6–5.8, P < 0.001).ConclusionsFindings emphasise the importance of integrated physical and mental healthcare before and during pregnancy for women with SMI.

Bipolar disorder (BD) differs in its clinical presentation in females compared to males. A number of clinical characteristics have been associated with BD in females: more rapid cycling and mixed features; higher number of depressive episodes; and a higher prevalence of BD type II. There is a strong link between BD and risk for postpartum mood episodes, and a substantial percentage of females with BD experience premenstrual mood worsening of varying degrees of severity. Females with premenstrual dysphoric disorder (PMDD)—the most severe form of premenstrual disturbances—comorbid with BD appear to have a more complex course of illness, including increased psychiatric comorbidities, earlier onset of BD, and greater number of mood episodes. Importantly, there may be a link between puberty and the onset of BD in females with comorbid PMDD and BD, marked by a shortened gap between the onset of BD and menarche. In terms of neurobiology, comorbid BD and PMDD may have unique structural and functional neural correlates. Treatment of BD comorbid with PMDD poses challenges, as the first line treatment of PMDD in the general population is selective serotonin reuptake inhibitors, which produce risk of treatment-emergent manic symptoms. Here, we review current literature concerning the clinical presentation, illness burden, and unique neurobiology of BD comorbid with PMDD. We additionally discuss obstacles faced in symptom tracking, and management of these comorbid disorders.

Intersecting gender and other social inequalities are pertinent to women’s mental health across the life course. Gendered violence and other forms of gender inequality in particular play a key role in the higher burden of psychological distress carried by young women. However, the context of gendered violence is often minimised or overlooked entirely when young women seek help or advice around mental health concerns. This is especially the case for young women under the age of 30 years. This paper reports on a research study exploring how young women in Australia understand their mental health, and the scope for new approaches to support that better address their needs. A qualitative survey undertaken with 52 Australian young women was used to explore the nature of their mental health experiences, sought to learn about the strategies they used when experiencing poor mental health and the scope for mental health peer support as an alternative approach to intervention. Responses from a diverse group of young women demonstrated that they understood the role that gendered violence and gender inequality played in their mental health. Findings point to the risk of slippage between young women’s understandings of their lived experience and those of traditional service providers, demonstrating the risks associated with minimising or ignoring of the gendered nature of young women’s mental health problems. Refereed/Peer-reviewed

The mental health of women living in poverty is a growing public health concern, particularly in India where the burden of illness is compounded by critical shortages in mental health providers and fragmented services. This was an exploratory study which sought to examine low-income women's perceptions of mental illness and its management in the context of urban poverty in India. This research was prompted by the lack of empirical studies documenting how women in marginalized sections of society understand mental illness. Data were collected through a combination of 10 focus group discussions and two individual interviews with a total of 63 women residing in low-income areas of Mumbai. Social representations theory was used to explore shared meanings of mental illness among women in this setting. Thematic analysis of the data showed that women use the expression "tension" to talk about mental illness. Tension was described both as an ordinary part of life and a condition having its origins in more profound gender-related stressors, particularly pressures surrounding motherhood, chronic poverty and domestic conflict. Approaches to managing tension were pluralistic and focused on the resumption of social roles. Findings are consistent with other studies in similar cultural contexts, suggesting a shared, transnational character to women's distress and the need for scholarship on women's mental health in low-income settings to be more attuned to gendered forms of marginalization.

The global pandemic caused by COVID-19 and the subsequent lockdown have been widely recognized as traumatic events that pose threats to psychological well-being. Recent studies reported that during such traumatic events, women tend to be at greater risk than men for developing symptoms of stress, anxiety, and depression. Several studies reported that a mindfulness-based stress reduction protocol (MBSR) provides useful skills for dealing with traumatic events. In our study, a sample of Italian females received an 8-week MBSR course plus 6 weeks of video support for meditation practice during the first total lockdown in Italy. We assessed the participants with questionnaires before and after this period to investigate their mindfulness skills, psychological well-being, post-traumatic growth, and psychological flexibility. After the intervention, the meditators group reported improvement in measures associated with self-acceptance, purpose in life, and relation to others compared to the control group. Furthermore, our results showed that participants with greater mindfulness scores showed high levels of psychological flexibility, which in turn was positively associated with higher levels of psychological well-being. We concluded that the MBSR could support psychological well-being, at least in female subjects, even during an unpredictable adverse event, such as the COVID-19 lockdown, by reinforcing key psychological aspects.

Background Major depressive disorder (MDD) affects 10% of pregnancies. Because transcranial magnetic stimulation (TMS) is a nonmedication option, psychiatric patients who do not tolerate or prefer to avoid antidepressants are good candidates for TMS. Method In a randomized controlled trial of twenty-two women with MDD in the second or third trimester of pregnancy, subjects were randomized to active TMS (n=11) or sham TMS (n=11). This study took place at a single academic center. Subjects received 20 sessions of TMS to the right dorsolateral prefrontal cortex at 1 Hz as a single train of 900 pulses per session at 100% motor threshold. Estradiol and progesterone and were measured before session 1 and after session 20. Results Results demonstrated significantly decreased Hamilton Depression Rating Scale (HDRS-17) scores for the active compared to the sham group (p=0.003). Response rates were 81.82% for the active and 45.45% for the sham coil (p=0.088). Remission rates were 27.27% for the active 18.18% for the sham coil (p=0.613). Late preterm birth (PTB) occurred in three women receiving active TMS. All other maternal and delivery outcomes were normal. Conclusions Right-sided, low frequency TMS was effective in reducing depressive symptoms in this sample of pregnant women. There may be a possibility that TMS is associated with late PTB although a larger sample size would be needed for adequate power to detect a true difference between groups. This study demonstrated that TMS is low risk during pregnancy although larger trials would provide more information about the efficacy and safety of TMS in this population. This trial shows that an RCT of a biologic intervention in pregnant women with psychiatric illness can be conducted.

Evaluation of a complex healthcare intervention should include careful exploration of the mechanisms through which it brings about change. This paper describes a qualitative evaluation of the Redesigning Daily Occupations (ReDO®-10) programme as it was implemented for the first time with women with stress-related issues in a primary care setting in Ireland. The ReDO®-10 is a 10-week group intervention designed to support participants make changes to their daily activity patterns to have a more satisfying and balanced daily life. Fourteen women were interviewed after completing the programme. The aim was to explore changes that participants perceived they experienced and to understand how the content of ReDO®-10 was thought to bring about this change (if it did). Directed content analysis was used to analyse the qualitative data using the Behaviour Change Wheel and Theoretical Domains Framework as a coding framework. Overall, four BCW functions of ReDO® -10 were identified: Education, Persuasion, Modelling and Enablement. Participants described improved belief in their own capabilities, knowledge and goals around life changes. Many behaviour changes were also described, particularly in relation to doing more restorative activities in daily life. Behaviour change techniques that were identified as important for change were practicing new, restorative occupations in group sessions and as homework and the use of self-analysis activities to understand the relationship between activities and health for these participants. Modelling, support and other effects of group dynamics were also vital in changes that occurred. peer-reviewed

Background: Radiotherapy, as a method of treatment of cervical and uterine cancers, may induce severe late-onset vaginal side effects. Unfortunately, little evidence on the management of adverse effects has been presented. This study aimed to evaluate the available interventions which reduce symptoms of vaginitis and vaginal atrophy by improving dyspareunia, mucosal inflammation, vaginal pH and vaginal dryness in women who have undergone brachytherapy or radiotherapy due to uterine or cervical malignancies. Materials and methods: A comprehensive literature search was performed following PRISMA guidelines. The systematic search was conducted using electronic databases, namely Scopus, Web of Science and PubMed, between October and November 2020 to identify randomized controlled trials (RCT) and, prospective randomized studies (PRS). Results: The analyzed population consists of 376 patients with uterine or cervical cancer, treated with hyaluronic acid, vitamin A, vitamin E, alpha-tocopherol acetate and dienestrol. Intervention with HA along with vitamin A and vitamin E revealed advantage in endpoints such as reduced dyspareunia, vaginal mucosal inflammation, vaginal dryness, bleeding, fibrosis and cellular atypia. Administration of alpha-tocopherol acetate reduced vaginal mucosal inflammation and improved vaginal acanthosis, whereas dienestrol resulted in reduced dyspareunia, vaginal caliber and bleeding. Conclusions: Vaginal suppositories were found to be clinically effective at the management of late-onset vulvovaginal side effects after radiotherapy.

Tema ovisnosti o alkoholu obično se povezuje s muškim osobama ovisnima o alkoholu, što je na neki način i razumljivo jer u cjelokupnoj populaciji muškarci zaista piju više od žena. Pijenje i opijanje žena od davnina je u obitelji i društvu oštrije osuđivano negoli isto ponašanje muškaraca. Upravo zbog takvog osuđivanja žene piju u tajnosti, duže skrivaju ovisnost od muškaraca te se teže odlučuju na bolničko ili psihosocijalno liječenje. U posljednjih nekoliko desetljeća u ženskoj je populaciji ovisnost o alkoholu u velikom porastu. Mijenja se tradicionalna uloga žene, posebno njezina obiteljska i radna uloga, te se žene susreću sa sve više stresnih situacija zbog kojih njihovo mentalno zdravlje pati. Sukladno navedenomu, alkoholizam u žena najčešće je popraćen narušenim mentalnim zdravljem, a nerijetko i sa psihičkim teškoćama. Protekla je 2020. godina u tom kontekstu bila posebno izazovna jer je međudjelovanje rizičnih čimbenika zbog COVID-19 pandemije i jakih potresa bilo puno izraženije. U ovom će se radu prikazati ovisnost o alkoholu u žena, upozorit će se na važnost očuvanja mentalnog zdravlja žena te će se pokušati sagledati učinak velikih događaja iz protekle godine na mentalno zdravlje žena i na njihove navike pijenja. Iznijet će se i mogućnosti unaprjeđenja podrške i pomoći ženama koje se bore s ovisnošću o alkoholu i narušenim mentalnim zdravljem. Sve u svrhu doprinosa razumijevanju ovoga problema, suočavanju s njime i mogućim rješenjima., The topic of alcohol addiction is usually associated with male alcohol addiction, which is in a way understandable because in the entire population men indeed drink more than women. Drinking and intoxicating women has long been more strongly condemned in the family and society than the same behavior of men. Precisely because of such condemnation, women drink in secret, hide their dependence on men for longer, and find it harder to decide on hospital or psychosocial treatment. In recent decades, alcohol dependence in the female population has been on the rise. The traditional role of women is changing, especially her family and work role, and women are facing more and more stressful situations that cause their mental health to suffer. Accordingly, alcoholism in women is most often accompanied by impaired mental health, often with mental difficulties. The year 2020 was particularly challenging in this context because the interaction of risk factors due to the COVID-19 pandemic and strong earthquakes was much more pronounced. This paper will present women's alcohol dependence, draw attention to the importance of preserving women's mental health, and try to look at the impact of major events from the past year on women's mental health and their drinking habits. Opportunities will also be presented to improve support and help women struggling with alcohol addiction and impaired mental health. All for the purpose of contributing to the understanding of this problem, dealing with it and possible solutions.

The mental health of women living in poverty is a growing public health concern, particularly in India where the burden of illness is compounded by critical shortages in mental health providers and fragmented services. This was an exploratory study which sought to examine low-income women’s perceptions of mental illness and its management in the context of urban poverty in India. This research was prompted by the lack of empirical studies documenting how women in marginalized sections of society understand mental illness. Data were collected through a combination of 10 focus group discussions and two individual interviews with a total of 63 women residing in low-income areas of Mumbai. Social representations theory was used to explore shared meanings of mental illness among women in this setting. Thematic analysis of the data showed that women use the expression “tension” to talk about mental illness. Tension was described both as an ordinary part of life and a condition having its origins in more profound gender-related stressors, particularly pressures surrounding motherhood, chronic poverty and domestic conflict. Approaches to managing tension were pluralistic and focused on the resumption of social roles. Findings are consistent with other studies in similar cultural contexts, suggesting a shared, transnational character to women’s distress and the need for scholarship on women’s mental health in low-income settings to be more attuned to gendered forms of marginalization.

Introduction: Argentinean quarantine during the COVID-19 pandemic is one of the most long-lasting worldwide. We focused on the first 80-days of this quarantine on Argentinean women. Our aims were to analyze differences in general mental health state (MHS) indicators, by the (1) sites of residence with different prevalence of COVID-19 cases, and (2) quarantine duration; (3) to assess multiple relationships between each general MHS indicator and potentially affecting factors. Methods: We used a cross-sectional design with convenience successive sampling (N = 5,013). The online survey included a socio-demographic questionnaire (elaborated ad hoc) with standardized and validated self-reported questionnaires (General Health Questionnaire, Kessler Psychological Distress Scale) measuring the MHS indicators: self-perceived health, psychological discomfort, social functioning and coping, and psychological distress. Results: Worse self-perceived health and higher psychological discomfort affected significantly more women residing in sites with high prevalence of COVID-19 cases, compared to those residing in sites with intermediate prevalence, but effect sizes were small. Mean scores of all general MHS indicators were significantly worse for longer quarantine sub-periods (up to 53, 68, and 80-day duration) than for shorter sub-periods (up to seven, 13, and 25-day duration). Being a younger age, having mental disorder history, and longer quarantine durations were associated to worsening MHS, while the lack of previous suicide attempt has a protective effect. Discussion: Our findings show that a worse MHS during quarantine may not be attributed to the objective risk of contagion (measured greater or less), and under quarantine, women MHS—as indicated by group central tendency measures—got worse as time went by. This strongly suggests that special attention needs to be paid to younger women and to women with history of mental disorder. Along with physical health, mental health must be a priority for the Government during and after quarantine and the COVID-19 pandemic. publishedVersion Fil: López Steinmetz, Lorena Cecilia. Universidad Nacional de Córdoba. Facultad de Psicología; Argentina. Fil: López Steinmetz, Lorena Cecilia. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Investigaciones Psicológicas; Argentina. Fil: López Steinmetz, Lorena Cecilia. Universidad Empresarial Siglo XXI; Argentina. Fil: Fong, Shao Bing. University of Melbourne; Australia. Fil: Leyes, Candela Abigail. Universidad Empresarial Siglo XXI; Argentina. Fil: Dutto Florio, María Agustina. Universidad Empresarial Siglo XXI; Argentina. Fil: Godoy, Juan Carlos. Universidad Nacional de Córdoba. Facultad de Psicología; Argentina. Fil: Godoy, Juan Carlos. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Investigaciones Psicológicas; Argentina.

The Covid-19 pandemic and subsequent public health measures were shown to impact negatively on people&rsquo, s mental health. In particular, women were reported to be at higher risk than men of developing symptoms of stress/anxiety/depression, and resilience was considered a key factor for positive mental health outcomes. In the present study, a sample of Italian female teachers (n = 66, age: 51.5 &plusmn, 7.9 years) was assessed with self-report instruments one month before and one month after the start of the Covid-19 lockdown: mindfulness skills, empathy, personality profiles, interoceptive awareness, psychological well-being, emotional distress and burnout levels were measured. Meanwhile, they received an 8-week Mindfulness-Oriented Meditation (MOM) course, through two group meetings and six individual video-lessons. Based on baseline personality profiles, analyses of variance were performed in a low-resilience (LR, n = 32) and a high-resilience (HR, n = 26) group. The LR and HR groups differed at baseline in most of the self-report measures. Pre&ndash, post MOM significant improvements were found in both groups in anxiety, depression, affective empathy, emotional exhaustion, psychological well-being, interoceptive awareness, character traits and mindfulness levels. Improvements in depression and psychological well-being were higher in the LR vs. HR group. We conclude that mindfulness-based training can effectively mitigate the psychological negative consequences of the Covid-19 outbreak, helping in particular to restore well-being in the most vulnerable individuals.

BackgroundWomen suffering from first onset postpartum mental disorders (PPMD) have a highly elevated risk of suicide. The current study aimed to: (1) describe the risk of self-harm among women with PPMD and (2) investigate the extent to which self-harm is associated with later suicide.MethodsWe conducted a register-based cohort study linking national Danish registers. This identified women with any recorded first inpatient or outpatient contact to a psychiatric facility within 90 days after giving birth to their first child. The main outcome of interest was defined as the first hospital-registered episode of self-harm. Our cohort consisted of 1 202 292 women representing 24 053 543 person-years at risk.ResultsAmong 1554 women with severe first onset PPMD, 64 had a first-ever hospital record of self-harm. Women with PPMD had a hazard ratio (HR) for self-harm of 6.2 (95% CI 4.9–8.0), compared to mothers without mental disorders; but self-harm risk was lower in PPMD women compared to mothers with non-PPMD [HR: 10.1, (95% CI 9.6–10.5)] and childless women with mental disorders [HR: 9.3 (95% CI 8.9–9.7)]. Women with PPMD and records of self-harm had a significantly greater risk for later suicide compared with all other groups of women in the cohort.ConclusionsWomen with PPMD had a high risk of self-harm, although lower than risks observed in other psychiatric patients. However, PPMD women who had self-harmed constituted a vulnerable group at significantly increased risk of later suicide.

Women reach out to health care providers for a multitude of health problems in the aftermath of intimate partner violence, including suicidality; however, little is known about how they seek help. The purpose of this study was to explore how women seek help for suicidality after intimate partner violence using a feminist grounded theory and photovoice multiple qualitative research design. Interviews were conducted with 32 women from New Brunswick, Canada, and seven from this sample also participated in five photovoice meetings where they critically reflected on self-generated photos of their help-seeking experiences. Data were analyzed using the constant comparative analysis of grounded theory. Hunting to Feel Human involves fighting for a sense of belonging and personal value by perceiving validation from health care providers. Women battled System Entrapment, a feeling of being dehumanized, by Gauging for Validation and Taking the Path of Least Entrapment. Implications for health care providers include prioritizing validating interactions and adopting a relational approach to practice.

Introduction Female sexual dysfunction (FSD) in depression albeit common is strikingly understudied. The condition, if addressed properly, can be readily cured, improving the quality of life of the patient. Methods A consecutive sample of drug-naïve married female patients with depression was assessed. Depression was diagnosed using the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I). Depression severity was assessed using the Hamilton Depression Rating Scale (HAM-D), and sexual dysfunction, the Female Sexual Function Index (FSFI). Results Sexual dysfunction was found in 90% of the patients in our study. Patients with medical comorbidities showed a significant decrease in the desire subset of the FSFI (Mann-Whitney U=11.0, p=0.009), however there was no significant association with other subsets. Patients who expressed passive death wishes had higher scores on all indicators of sexual function and a significantly higher score in the orgasm subset of the FSFI (Mann-Whitney U=11.0, p=0.009). Conclusion The study showed a high prevalence of FSD in depressed females regardless of type and severity of depression. Depression with medical comorbidities was associated with a significant decrease in desire. Patients who expressed passive death wishes showed improved sexual function and significantly better orgasm. Resumo Introdução Disfunção sexual feminina (DSF) na depressão, apesar de comum, é pouco estudada. Se tratada adequadamente, a condição pode ser prontamente curada, aumentando a qualidade de vida da paciente. Métodos Foi avaliada uma amostra consecutiva de mulheres casadas, virgens de tratamento, com depressão. A depressão foi diagnosticada utilizando a Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I). A gravidade da depressão foi avaliada utilizando a Escala de Avaliação de Depressão de Hamilton (HAM-D), e a disfunção sexual, com o Índice da Função Sexual Feminina (Female Sexual Function Index, FSFI). Resultados Foi observada disfunção sexual em 90% das pacientes do estudo. As pacientes com comorbidades médicas mostraram uma diminuição significativa no subdomínio desejo da FSFI (Mann-Whitney U=11,0, p=0,009), porém não houve associação significativa com os outros subdomínios. Pacientes que expressaram desejos passivos de morte apresentaram escores mais altos em todos os indicadores de função sexual e um escore significativamente mais alto no subdomínio orgasmo da FSFI (Mann-Whitney U=11,0, p=0,009). Conclusão O estudo revelou uma alta prevalência de DSF em mulheres deprimidas, independentemente do tipo e da severidade da depressão. A depressão com comorbidades médicas foi associada a uma diminuição significativa do desejo. Pacientes que expressaram desejos passivos de morte mostraram função sexual melhor e orgasmo significativamente melhor.

Gender-based violence (GBV), characterized by the abduction or rape of women and girls to humiliate, intimidate, and traumatize them and their communities, is a profoundly disturbing tactic in international conflict. Long after armed conflict has ended, survivors continue to experience physical injuries, psychological trauma, and social and cultural stigma. Guilt, shame, and continued interpersonal violence can become a normalized part of daily life, significantly challenging the road to healing and recovery. Research about self-disclosure and narrative after GBV has shown that help seeking rates are shockingly low, with estimates ranging from 4-27%. From a feminist and a humanistic perspective, studying trauma history and related help seeking is delicate work that must use interview processes that ensure the survivor can tell her story without revictimization, while also aiming to restore personal mastery, empowerment, and self-understanding. Based on theories about benefits and challenges of the narrative after GBV and trauma, we propose that the Clinical Ethnographic Narrative Interview (CENI) allows researchers and practitioners a safe container to examine the complex interplay between suffering, culture, and help seeking. Using this interview, the interviewer and the participant work as partners to define, compare, and contrast the socio-cultural barriers and facilitators of help seeking. This paper explains the narrative theory and the challenges and benefits of the narrative approach after trauma. Then we provide support for the use of the CENI for an understanding of the help seeking process and facilitating a health-promoting narrative interview for survivors. We then address implications for research, practice, and policy.

Background Studies show that migrant women are at greater risk of common mental disorders than the majority population, yet underrepresented in healthcare services. This study investigates the use of outpatient mental healthcare services over a five-year period among migrant and descendant women compared to majority women in Norway. Methods Using linked national registry data, we selected all women resident in Norway between 2009 and 2013 (N = 1,834,822). We conducted generalised estimated equations with logistic regression to assess if the odds of using outpatient mental healthcare services differed for migrant and descendant women compared to majority women. We also conducted generalised estimated equations with negative binomial regression to calculate consultation incidence rate ratios for migrant and descendant women relative to majority women among those with a common mental disorder. Results Both migrant and descendant women had lower odds (OR = 0.47 and OR = 0.60 respectively) of using outpatient mental healthcare services than majority women. Odds of using services increased with length of residency. We also found significant variation by country of origin. Among women with common mental disorders who had used services, migrants, but not descendants, had a lower consultation rate ratio than majority women. Analyses by region of origin revealed that this did not apply to women from EU European countries, North America and Australia and New Zealand. Conclusion Women with migrant background are, overall, underrepresented in OPMH services. Findings indicate that migrant women may not only experience barriers to seeking and accessing care but also in maintaining access to care. This may especially be the case for newly arrived migrant women and women from non-Western countries. Treatment may not be culturally adapted for these groups. Closer investigation of the barriers migrant women experience after using OPMH services is required.

Depression during the childbearing years affects between 10-15% of women, and amongst the detrimental effects to health is lowered Physical Activity (PA) behaviour. While modalities of exercise and PA behaviour have been identified as having a positive effect on the depression condition as well as other heath indices (e.g., weight and adiposity), its effectiveness remains uncertain during the postnatal and antenatal stages. Postnatal Depression (PND) and Antenatal Depression (AND) are predominantly treated with antidepressants and counselling; and even while acknowledging potential movement associated with pregnancy, emerging evidence suggests exercise/PA could be a potentially feasible and cost-effective, adjunct, treatment behaviour. Thesis findings suggest that exercise/PA interventions could have specific preventative and symptom treatment roles. Thus, exercise/PA guidelines can be recommended

International audience; Purpose: Women are disproportionately likely to suffer from depression. This is especially true for those who experience socioeconomic hardship, such as homelessness. In France, among homeless mothers many are migrant. However, it is not clear whether risk factors associated with depression are specific for this group or the same as in the general population. Our objective was to describe socio-demographic, relational, living and housing conditions and health factors associated with depression among homeless mothers. Methods: The ENFAMS survey, conducted via face-to-face bilingual interviews with a representative sample of homeless families in the Paris region (January-May 2013, n = 733 mothers). Mothers reported their socio-demographic characteristics, housing conditions including residential mobility, as well as physical and mental health. Depression was ascertained using the Composite International Diagnostic Interview (CIDI). Factors associated with mother's depression were studied in weighted Poisson regression models with robust error variance. Results: The prevalence of depression among participating mothers was 28.8%. In multivariate analyses, depression was associated with fluency in French (PR = 1.88 95% CI 1.40; 2.51), suicide risk (PR = 2.26, 95% CI 1.82; 2.82), post-traumatic stress disorder (PR = 1.97, 95% CI 1.50; 2.60), and unmet health needs (PR = 1.68, 95% CI 1.09; 2.57). Conclusions: Homeless mothers have high levels of depression and associated psychiatric comorbidities. Associated risk factors appear to be both specific for this group and shared with mothers in the general population. Improvements in the monitoring of mental health difficulties as well as access to appropriate medical care in this vulnerable population may help improve health and social outcomes.

Background Menopause can be a time of change for women and may be marked by disturbances in mood. For women living with a mental illness, such as bipolar disorder, little is known about how they experience mood changes during menopause. This study aimed to explore how women with bipolar disorder constructed mood changes during menopause and how this impacted on treatment decisions. Methods Semi-structured interviews were undertaken with fifteen women who reported they had been diagnosed with bipolar disorder. Data was analysed using thematic analysis guided by a social constructionist framework. Results Themes identified included ‘Constructions of mood change: menopause or bipolar disorder?’,‘ Life events, bipolar disorder and menopause coming together’; ‘Treatment choices for mood change during menopause’. Conclusions The accounts suggested that women related to the experience of mood changes during menopause through the lens of their existing framework of bipolar disorder, with implications for understanding of self and treatment choices. Electronic supplementary material The online version of this article (10.1186/s12905-017-0467-y) contains supplementary material, which is available to authorized users.

This study describes a qualitative inquiry–informing program development in a maternal and child home visiting program. Low-income women's perceptions of the meaning and experiences of depression were ascertained through focus groups and interviews. Simultaneously, the study examines staff member perceptions and roles related to depression. Specific findings from clients and staff reveal culturally situated beliefs about depression and stressful life events; comparing and contrasting these beliefs offers a novel perspective on identification and intervention for maternal depression. This study offers a foundation for a translational research agenda that will be used for program and policy development to enhance mental health services situated within maternal and child health home visiting programs.

The recent modifications to the classificatory systems were expected to enhance the recognition of various psychiatric conditions specific to women. Several researchers and clinicians had made specific recommendations regarding four main conditions; that is, female sexual dysfunction (FSD), perinatal psychiatric disorders (PPDs), and premenstrual dysphoric disorder and eating disorders; to improve the clinical utility of these diagnoses. While FSD has undergone considerable change with its own special place outside of mental health, not all suggestions regarding PPDs were considered. A major advance in both Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5) and International Classification of Diseases (ICD11) has been the inclusion of the antenatal period in PPDs, which had hitherto been left out. However, two recommendations related to PPDs-increase in the time frame of the postpartum definition and inclusion of mother–infant interaction disorders were not considered, which we believe are valuable opportunities lost. Substantial changes have been included in the clinical manifestations and course of eating disorders, based on evidence and cross-cultural differences. One condition included in ICD-11 which may help women get better treatment is complex posttraumatic stress disorder. It appears that while there are some changes that are positive, more could have been achieved for women's mental health.

Violence against women, which refers to any violent behavior that leads to sexual and physical damage and/or pain in women, counts as their main health and human right problem. Poor economic and social status of women in most societies coupled with cultural and religious biases as well as a frequent lack of supportive legislations have made wife-abuse a widely resorted solution on the part of partners. This descriptive study embarked on estimating mental problems among abuse victims. A sample of available 60 abused women referring to forensic department and a group of 60 randomly selected normal women were studied. The instruments consisted of a researcher-made demographic questionnaire, and MMPI and SCL-90-R tests. The findings showed that except for Lie, Hypomania, Hysteria and Schizophrenia according to MMPI, and except for Psychotism according to SCL-90-R, the abused group was suffering from more psychic problems as compared to the normal group. Also, the average education of the normal group was significantly higher than the abused group.

Background. In striving to achieve the UN Millennium Development Goals, Pakistan pledged to focus on eradicating extreme poverty for its population. The association between socio-economic status and health is well established. Micro-finance institutions provide access to credit for poor women where cultural and social constraints limit their opportunities for economic advancement. While involvement in a micro-finance program has been shown to reduce poverty, little is known about how this involvement impacts women’s mental health. Objective. The purpose of this qualitative study was; (a) to gain an understanding of how women conceptualize the meaning of their mental health; (b) to explore the impact of women participation in micro-finance programs on their mental health; (c) to determine how they promote their mental health; and (d) to obtain their recommendations for change to micro-finance institutions. Methods. Using interpretive description methodology, data were collected and analyzed through interviews with 32 urban-dwelling women who have been micro-finance loan recipients for a period of 1 to 5 years. A total of six micro-finance administrative personnel were also interviewed; five institutional documents were reviewed. Data were analyzed in the source language Urdu, following three main phases of content analysis methods, preparation, organization and reporting. Results. Women conceptualize mental health as being the presence of peace and the absence of tension. Participants relate this tension to absence of basic resources in their day-to-day living and lack of safety and security around the city. Women recognized micro-finance programs as being a major inspiration towards their flourishing mental health. Regular practice of religion, being resilient towards adversity and securing family respect through a consistent source of income and repayment of the loans were identified approaches to promoting mental health. In enhancing micro-finance programs further, the women recommended for them to initiate vocational training institutions and to provide opportunities for their children to seek education at affordable cost. Conclusion. The women participants of this study represented “everyday women” of Pakistan, who thrive through their resilience and courage to mitigate poverty and to achieve peace. Combating obstacles to meet the basic needs, including access to education, would be a useful first step towards mental health promotion for Pakistani women. Financial services of micro-finance, along with provision of vocational skills training, “women-to-women” approach and modifications in policy would assist women to utilize their loan productively. Multiple stakeholders should work collaboratively for the promotion of mental health determinants. As nurses are now moving beyond the traditional roles and counteracting complex issues, this study identifies implications for research, education, and practice. Thesis Doctor of Philosophy (PhD)

Studies that examine the effects of neighborhood characteristics on mental health show that perceptions of general neighborhood violence are associated with depression across diverse populations (Clark etal., 2008; Velez-Gomez etal., 2013; Wilson-Genderson & Pruchno, 2013). However, to our knowledge, none have examined the specific effect of perceived frequency of neighborhood domestic violence (PFNDV) on residents' mental health, despite knowledge that domestic violence is a potent predictor of depression at the level of the individual. This study investigates the impact of PFNDV on mental health using the South African National Income Dynamics Study (SA-NIDS). NIDS Waves 2 and 3 measure the perceived frequency of six neighborhood violence subtypes through the NIDS household respondent questionnaire and depression through a questionnaire administered to all NIDS participants. Linear regression was used to model the relationship between change in depression symptoms and change in violence subtypes between Waves 2 and 3. We found that two-year increase in PFNDV was significantly correlated with increase of depression symptoms over the same time period for women, independently of individual, household and neighborhood level characteristics, including five other types of neighborhood violence. No other type of violence was associated with increased depression in women in the fully adjusted model. Research and policy implications are discussed.

Introduction: The chapter deals with the current situation of women in Italy by examining the impact that Italian social and economic conditions have on women’s mental health. The framework adopted considers women’s mental health as a major public health issue; thus mental health is considered as the effect of sequels of distressing events experienced by women.

A conscientização de que os transtornos mentais representam um sério problema de saúde pública é relativamente recente, ocorrendo a partir da publicação do estudo The Global Burden of Disease pela Organização Mundial da Saúde. Diferenças de gênero na incidência, prevalência e curso de transtornos mentais, assim como na apresentação clínica e na resposta terapêutica, têm sido extensivamente demonstradas por estudos epidemiológicos.The awareness that mental disorders present a serious public health problem is relatively new, occurring after the publication of The Global Burden of Disease by the World Health Organization. Gender differences in the incidence, prevalence, and course of mental disorders, as well as in their clinical features and response to treatment; have been extensively demonstrated in epidemiological studies.

Women’s health has traditionally beenthoughtofintherealmofreproduc-tive health, and that includes women’smental health (i.e., perinatal psychiatry).However, we now know there are sig-nificant sex differences in many chronicdiseases, including brain disorders. Thus,understanding the causes of sex differ-ences in disorders of the brain, withinand outside of reproduction, is criticalto understanding women’s mental healthand healthcare needs. In order to accom-plish this, it is necessary for neuroscienceto adopt a “sex-dependent” and/or “sex-specific” lens on investigations of thebrain. In this review, we make the case fordepression, which has among the largestsex differences in disorders of the brain.Major depressive disorder (MDD)recently became the number one cause ofdisability worldwide (Murray and Lopez,1997; Ustun et al., 2004; World HealthOrganization, 2012). Importantly, theincidence of MDD in women is twicethat of men (Kessler, 2003; Kendler et al.,2006), and thus understanding its patho-physiology has widespread implicationsfor attenuation and prevention of dis-ease burden, particularly in women. Over40 years of research implicate hormonaldysregulation underlying mood disorders(Boardetal.,1956;GibbonsandMcHugh,1962; Coplan et al., 2000; Brouwer et al.,2005; Kurt et al., 2007; Barim et al., 2009),particularlyinvolvementofhypothalamic-pituitary-adrenal (HPA) and HP-gonadal(HPG) axes (Board et al., 1956; Gibbonsand McHugh, 1962; Plotsky et al., 1998;Young and Korszun, 2002; Swaab et al.,2005). Central dysregulation of hormonalaxes can precede MDD onset suggest-ing a role for hormonal abnormalitiesin female MDD vulnerability. Ours andothers’ work demonstrated that the vul-nerabilityforsex-dependentriskforMDDbegins in

Obsessive-compulsive disorder (OCD) is heterogeneous. Clinical presentation of OCD differs by sex and age-of-onset and evidence supports classification based on these subtypes. The prevalence of OCD in the general population is 2%. However, it has been established that women tend to experience onset and exacerbation of OCD during reproductive milestones. In particular, the prevalence of postpartum OCD is between 4 to 9%. This study seeks to examine the effects of past childhood maltreatment and S/Lg-allele status of the 5-HTTLPR polymorphism on perinatal obsessive-compulsive symptoms and aberrant resting state functional connectivity in the postpartum period. Forty women participated in the first visit and sixteen women have been followed up with in the postpartum period. 5-HTTLPR genotype was determined from whole blood samples via polymerase chain reaction and a restriction fragment length digest. We used the Yale-Brown Obsessive-Compulsive Scale and Perinatal Obsessive-Compulsive scale to measure symptom severity. Resting state functional connectivity was determined from functional magnetic resonance imaging data. Obsessive-compulsive symptoms during late pregnancy are significantly predicted by 5-HTTLPR genotype, past history of total childhood maltreatment or childhood emotional neglect and trait anxiety symptoms. Whereas obsessive-compulsive symptoms during the postpartum period are predicted by poor sleep quality and childhood emotional maltreatment or 5-HTTLPR genotype, childhood emotional maltreatment and trait anxiety symptoms. Seed to region-of-interest analysis was employed to evaluate resting state functional connectivity differences between OCD patients and healthy controls in the postpartum period. Compared to healthy controls, OCD patients show greater connectivity between the caudate nucleus with the orbitofrontal cortex, the pars triangularis and the cingulate area. The insular cortex shows decreased connectivity between the right and left, the dorsal anterior cingulate area and the pars opercularis. The amygdala has increased connectivity with the cingulate area, the calcarine fissure, the supramarginal gyrus and decreased connectivity with the gyrus rectus. The above clinical and neuroimaging findings are in line with past work. However, this is the first study to show both 5-HTTLPR genotype and history of childhood maltreatment predict obsessive-compulsive symptoms in a perinatal population. Further, the resting state data replicates findings in the OCD literature but the study is the first to show this in postpartum women. This study serves as a platform for future work to further investigate both gene-environment interactions and distinct neuroimaging correlates in perinatal OCD. Thesis Master of Science (MSc)

Background to the study: Women’s experiences of mental health and homelessness are multi-faceted and undeniably intertwined. Yet both are social problems hidden from the political and social agenda despite calls from women’s groups and lobbyists (NWCI & Women’s Health Council) to change this. The ‘revolving door’ between mental health services and homelessness is a clear indication that services do not adequately respond to these women’s needs. The Good Shepherd Aftercare services (hereafter referred to as GSS) have taken the initiative to research this area due to an increasing number of their clients presenting with mental health difficulties. The GSS anticipates the findings will enable them to tailor services that would meet the client’s specific needs. Objectives: The overall objectives of this study are to firstly: review the literature relating to women’s mental health and homelessness from a feminist perspective. Secondly: to compile a list of mental health support services in the Cork area. Thirdly: to gain the perspectives of the women who access the GSS on what their experiences of mental health services were, to use this information to address ‘gaps’ in current service and identify areas where innovative change can be applied.

Background Previous studies have found high levels of symptoms of depression, anxiety, and post-traumatic stress disorder among women survivors of human trafficking. No previous research has described risk factors for diagnosed mental disorders in this population. Methods A historical cohort study of women survivors of trafficked women aged 18 and over who returned to Moldova and registered for assistance with the International Organisation for Migration (IOM). Women were approached by IOM social workers and, if they gave informed consented to participate in the study, interviewed by the research team. At 2–12 months post-return to Moldova, a psychiatrist assessed DSM-IV mental disorders blind to information about women’s pre-trafficking and post-trafficking experiences using the Structured Clinical Interview for DSM-IV (SCID). A backwards stepwise selection procedure was used to create a multivariable regression model of risk factors for DSM-IV mental disorder measured at an average of 6 months post-return. Results 120/176 (68%) eligible women participated. At an average of 6 months post-return, 54% met criteria for any DSM-IV mental disorder: 35.8% of women had PTSD (alone or co-morbid), 12.5% had depression without PTSD and 5.8% had another anxiety disorder. Multivariable regression analysis found that childhood sexual abuse (Adjusted Odds Ratio [AOR] 4.68, 95% CI 1.04-20.92), increased number of post-trafficking unmet needs (AOR 1.80; 95% CI 1.28-2.52) and post-trafficking social support (AOR 0.64; 95% CI 0.52-0.79) were independent risk factors for mental disorder, and that duration of trafficking showed a borderline association with mental disorder (AOR 1.12, 95% CI 0.98-1.29). Conclusions Assessment for mental disorders should be part of re-integration follow-up care for women survivors of human trafficking. Mental disorders at that time, most commonly PTSD and depression, are likely to be influenced by a range of predisposing, precipitating and maintaining factors. Care plans for survivors of trafficking must be based on individual needs, and must apply clinical guidelines for the treatment of PTSD and of depression. Evidence is needed on the effectiveness of therapy for PTSD in survivors of human trafficking.

Background: Much recent debate on excess rates of compulsory detention and coercive routes to care has focused on young black men; evidence is less clear regarding ethnic variations among women and factors that may mediate these. Aim: To explore ethnic variations in compulsory detentions of women, and to explore the potential role of immediate pathways to admission and clinician-rated reasons for admission as mediators of these differences. Method: All women admitted to an acute psychiatric inpatient ward or a women’s crisis house in four London boroughs during a 12-week period were included. Data were collected regarding their pathways to care, clinician-rated reasons for admission, hospital stays, and social and clinical characteristics. Results: Two hundred and eighty seven (287) women from white British, white other, black Caribbean, black African and black other groups were included. Adjusting for social and clinical characteristics, all groups of black patients and white other patients were significantly more likely to have been compulsorily admitted than white British patients; white British patients were more likely than other groups to be admitted to a crisis house and more likely than all the black groups to be admitted because of perceived suicide risk. Immediate pathways to care differed: white other, black African and black other groups were less likely to have referred themselves in a crisis and more likely to have been in contact with the police. When adjustment was made for differences in pathways to care, the ethnic differences in compulsory admission were considerably reduced. Discussion: There are marked ethnic inequities not only between white British and black women, but also between white British and white other women in experiences of acute admission. Differences between groups in help-seeking behaviours in a crisis may contribute to explaining differences in rates of compulsory admission.

A conscientização de que os transtornos mentais representam um sério problema de saúde pública é relativamente recente, ocorrendo a partir da publicação do estudo The Global Burden of Disease pela Organização Mundial da Saúde. Diferenças de gênero na incidência, prevalência e curso de transtornos mentais, assim como na apresentação clínica e na resposta terapêutica, têm sido extensivamente demonstradas por estudos epidemiológicos. The awareness that mental disorders present a serious public health problem is relatively new, occurring after the publication of The Global Burden of Disease by the World Health Organization. Gender differences in the incidence, prevalence, and course of mental disorders, as well as in their clinical features and response to treatment; have been extensively demonstrated in epidemiological studies.

A conscientização de que os transtornos mentais representam um sério problema de saúde pública é relativamente recente, ocorrendo a partir da publicação do estudo The Global Burden of Disease pela Organização Mundial da Saúde. Diferenças de gênero na incidência, prevalência e curso de transtornos mentais, assim como na apresentação clínica e na resposta terapêutica, têm sido extensivamente demonstradas por estudos epidemiológicos. The awareness that mental disorders present a serious public health problem is relatively new, occurring after the publication of The Global Burden of Disease by the World Health Organization. Gender differences in the incidence, prevalence, and course of mental disorders, as well as in their clinical features and response to treatment; have been extensively demonstrated in epidemiological studies.